Surgical Hair Restoration Procedures

Surgical Therapy

Surgical therapy includes the invasive approach to hair restoration. There are several methods used in hair restoration today. The two main hair restoration procedures are the strip excision and a newer and advanced technology called Follicular Unit Extraction (FUE).

What is FUE?

Simply put, FUE is circular punch that is less than 1.0mm in diameter that is used to extract follicular grafts from the donor region to be placed naturally in the recipient area of a balding area. It is actually an overhaul to the old 1980’s “Plugs” that used 3-4mm circular punches and could extract 10 follicular units in one punch. However, this proved to be terribly unnatural in the recipient area and scarred the donor area with large circular scars. What the USA team did was use a small 1.omm biopsy punch and slowly over time changed the punch material, the size of the punch and the biggest feat was the use of professional grade Carl Zeiss Neuro-Surgical Prism Loupes. The follicular unit cannot be visualized without the aid of specific surgical loupes. Unfortunately, not many clinics adopted this critical component but a handful of us did and use them today.

FUE is a less invasive procedure than its counterpart the “strip”. There are no sutures. Healing times are vastly rapid, with low post-operative pain. Typically, you are back to full activities including exercise in one week. The donor area heals within a couple of days with no perception of the procedure after 5-7 days.

When a patient undergoes an FUE procedure here, we break down the day into 3 parts.

1. You will come into the clinic early at 6:30 A.M. Dr. Guillot will re-review your master plan and fine tune your hair loss needs. After this you will sign the necessary forms of consent. (We will also ask if we can use your before and after pictures to show future patients during consultations and ask for your permission to show your results on our website WITH or WITHOUT your face shown. This is solely your decision and if you decide not participate by showing your results we are bound by strict laws to keep your privacy). Next it is time to dress you out, shave your donor area (the back and the sides) so we can extract the follicles. You will be sitting upright so you will watch movies, browse on the internet, or chat with us during the extractions. We will give local anesthetic to completely numb the donor area. Finally, we will extract follicle groups for the next 4 hours depending on the case size. As the follicles are extracted a hair technologist will help in the process by following the extractor; gently pulling out the follicles. She will then count every graft under the microscope. She will separate the grafts into 1’s, 2’s, 3’s, 4’s etc. This is monumentally important because the arrangement of these follicles in the balding areas must follow specific rules to provide a natural and undetectable transplant.

Above are pictures of extracted follicles from our procedure.

The first petri-dish is just after collection from the donor.

The next picture are 5 separated grafts. From the left: 3-haired graft, another 3-haired graft, 2-haired graft, another 2-haired graft, and finally a 1-haired graft.

2. Around 12-12:30 P.M. the extractions should be complete. We will then break for a lunch that we will provide. Around 12:40 P.M. or less its back in the surgical chair. However, at this time we may give you a light sedative. You will lay back in a head rest so we can anesthetize the recipient area. Then it is time to make all of the sites in your areas of concern. Hairline design is important; we will arrange the smallest 1-haired grafts in the very front (2-3-Rows) And then 2’s, 3’s, 4’s are randomly mixed behind the hairline. Larger grafts will be placed in the center and crown if need be. A natural undetectable hairline and a adding density going back must be gradual and not a “harsh or stark” hairline from large grafts placed in the very front.

A harsh, pluggy unnatural hairline.

The pre-op picture for the next picture.

A more aesthetically pleasing natural Hairline from our FUE team.

3. The third and final part of the day is placing every extracted follicle graft into the sites that were created.

This will take up the remainder of the day. Many patients sleep through this part and others watch movies. When all of the grafts are finally placed, then we will give you a set of post op instructions that must be followed completely so that your new grafts have the best chance of survival. You will also be given a post-operative spray, cream, shampoo. This completes your hair restoration day.